Liu Zhihua, Mitchell Timothy J, Luo Chongliang, Park Ki Yun, Shimony Joshua S, Fucetola Robert, Leuthardt Eric C, Perkins Stephanie M, Snyder Abraham Z, Zhu Tong, Huang Jiayi
Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri.
Division of Public Health Sciences, Washington University School of Medicine, St Louis, Missouri.
Int J Radiat Oncol Biol Phys. 2025 Sep 1;123(1):93-106. doi: 10.1016/j.ijrobp.2025.03.017. Epub 2025 Mar 17.
This prospective observational study employed resting-state functional magnetic resonance imaging (rs-fMRI) to investigate network-level disturbances associated with neurocognitive function (NCF) changes in patients with gliomas following partial-brain radiation therapy (RT).
Adult postoperative patients with either isocitrate dehydrogenase (IDH)-wild-type or IDH-mutant gliomas underwent computerized NCF testing and rs-fMRI at baseline and 6 months post-RT. rs-fMRI data were assessed using seed-based functional connectivity (FC). NCF changes were quantified by the percent change in age-normalized composite scores from baseline (ΔNCF). Connectivity regression analysis assessed the association between network FC changes and NCF changes, using a split-sample approach with a 26-patient training set and a 6-patient validation set, iterated 200 times. Permutation tests evaluated the significance of network selection.
Between September 2020 and December 2023, 43 patients were enrolled, with 32 completing both baseline and follow-up evaluations. The mean ΔNCF was 2.9% (SD, 13.7%), with 38% experiencing a decline. Patients with IDH-mutant glioma had similar NCF changes compared with those with IDH-wild-type glioma. Intrahemispheric FC was similar between ipsilateral and contralateral hemispheres for 91% of patients at baseline, and 69% had similar intrahemispheric FC change posttreatment. FC changes accounted for a moderate fraction of variance in NCF changes (mean R, 0.301; SD, 0.249), with intranetwork FC of the parietal memory network (PMN-PMN, P = .001) and internetwork FC between the PMN and the visual network (PMN-VN, P = .002) as the most significant factors. Similar findings were obtained by sensitivity analyses using only the FC data from the hemisphere contralateral to the tumor.
Post-RT rs-fMRI changes significantly reflected NCF decline, highlighting rs-fMRI as a promising imaging biomarker for neurocognitive decline after RT.
本前瞻性观察性研究采用静息态功能磁共振成像（rs-fMRI）来探究部分脑放射治疗（RT）后胶质瘤患者中与神经认知功能（NCF）变化相关的网络水平干扰。
成年术后异柠檬酸脱氢酶（IDH）野生型或IDH突变型胶质瘤患者在基线期和放疗后6个月接受计算机化NCF测试和rs-fMRI检查。rs-fMRI数据使用基于种子的功能连接（FC）进行评估。NCF变化通过与基线期年龄标准化综合评分的百分比变化（ΔNCF）进行量化。连接性回归分析使用包含26例患者的训练集和6例患者的验证集的拆分样本方法评估网络FC变化与NCF变化之间的关联，重复200次。置换检验评估网络选择的显著性。
2020年9月至2023年12月期间，共纳入43例患者，其中32例完成了基线期和随访评估。平均ΔNCF为2.9%（标准差，13.7%），38%的患者出现下降。IDH突变型胶质瘤患者与IDH野生型胶质瘤患者的NCF变化相似。91%的患者在基线期同侧和对侧半球的半球内FC相似，69%的患者在治疗后半球内FC变化相似。FC变化在NCF变化中占中等比例的方差（平均R，0.301；标准差，0.249），顶叶记忆网络的网络内FC（PMN-PMN，P = .001）以及PMN与视觉网络之间的网络间FC（PMN-VN，P = .002）为最显著因素。仅使用肿瘤对侧半球的FC数据进行敏感性分析也获得了相似结果。
放疗后rs-fMRI变化显著反映了NCF下降，突出了rs-fMRI作为放疗后神经认知下降的一种有前景的成像生物标志物。
